'Tommy John' Surgery Gets Major League Pitchers Back on the Mound
Study found most players returned to pro baseball, sometimes with better results
TUESDAY, March 11, 2014 (HealthDay News) -- So-called "Tommy John" surgery is very effective at getting Major League Baseball (MLB) pitchers back in the game, new research has found.
Four out of five MLB pitchers who underwent Tommy John surgery to repair a torn elbow ligament eventually returned to play, and pitched as well as they had before their injury.
They even won more often after their surgery compared to players who never underwent the surgery, the study authors reported Tuesday at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), in New Orleans.
"It used to be a career-ending injury. Today, it's a one- or two-season-ending injury," said Dr. William Levine, an AAOS spokesman and director of the sports medicine department of orthopedic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Tommy John surgery fixes a torn ulnar collateral ligament, or UCL. The UCL is located on the inside of the elbow and connects the bone of the upper arm to a bone in the forearm.
This injury occurs in baseball mainly to pitchers, but it also can affect catchers due to the number of times they throw during a game, said Levine, who was not involved with the study.
"It's a repetitive overuse trauma scenario. The torque on the elbow is phenomenally higher than the ligament can stand," Levine said. He noted that the surrounding muscles and the players' own technique are the only things that prevent even more torn UCLs from taking place. "It's a mismatch of the force and energy that ligament sees versus what it can withstand," he explained.
In the procedure, surgeons replace the injured UCL with a tendon taken from the player's own body, usually either the forearm or the knee, Levine said.
The surgery is named after the first ball player to undergo the procedure, former Los Angeles Dodgers pitcher Tommy John. His surgery occurred in 1974.
In the study, doctors with Midwest Orthopaedics at Rush University Medical Center in Chicago scoured MLB records to identify pitchers who underwent Tommy John surgery between 1986 and 2012.
The researchers found 179 pitchers who underwent Tommy John surgery and looked at their performance. "We took their stats from before surgery and took their same data from after surgery, and compared them," said study author Dr. Brandon Erickson, a resident with Midwest Orthopaedics at Rush.
They also compared the players to a group of pitchers who never received surgery.
Among their findings were the following:
About 83 percent of the pitchers successfully returned to Major League play, and overall 97 percent returned to play in either the major or the minor leagues.
Five pitchers receiving Tommy John surgery were never able to play again.
About 4 percent of surgeries required revisions.
Pitchers generally played better following Tommy John surgery. They allowed fewer walks and gave up fewer hits, runs and home runs. "Their pitching performance was declining due to their injury, and that's why they had the surgery," Erickson said. However, pitchers also played in fewer innings following surgery.
Pitchers who underwent the surgery appeared to play better than the comparison group of pitchers who didn't need Tommy John reconstruction. They walked fewer batters and gave up fewer hits per inning.
The study was published recently in the American Journal of Sports Medicine.
"The surgery is not 100 percent," Levine said. "But if you're a major league ball pitcher and you do have to have the surgery, knowing that 83 percent of your colleagues are able to get back to their previous level of performance is encouraging."
However, both Erickson and Levine expressed concern that these findings might encourage younger players at the high school or college level to undergo Tommy John surgery in the mistaken belief that it could improve their game.
"If you are a college, junior high or high school player and you have to have Tommy John surgery before you get to the major leagues, it does not improve your chances of eventually getting to the major leagues," Levine said. "It doesn't make you stronger, better or faster. But if you have the talent to be in the major leagues as a pitcher and you tear your elbow ligament, we can say pretty conclusively there is a high rate of return to pitching at the previous level."
Erickson added that these players excelled because they did a good job in physical rehabilitation before returning to the game.
"They rested and made sure they were healthy before they returned," he said.
For more about Tommy John surgery, visit Oregon Health & Science University (http://www.ohsu.edu/xd/health/services/ortho/getting-treatment/medial-ulnar-collateral.cfm ).
SOURCES: Brandon Erickson, M.D., Midwest Orthopaedics, Rush University Medical Center, Chicago; William Levine, M.D., spokesman, American Orthopaedic Society for Sports Medicine, and director, sports medicine department of orthopedic surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York City; March 11, 2014, presentation, American Academy of Orthopaedic Surgeons meeting, New Orleans
2 Surgeries Work Equally Well for Female Incontinence, Study Finds
Doctors can choose the one they're more familiar with, expert says
TUESDAY, March 11, 2014 (HealthDay News) -- Two surgeries are equally effective and safe for women who have pelvic problems that can cause pain and incontinence, say the authors of a new study.
Pelvic organ prolapse is a weakening of the pelvic organs often seen in older women and those who've given birth several times. Surgeons typically choose one of two procedures to repair the condition, but little hard data has been available to back up their choice.
This study of nearly 400 women at nine U.S. medical centers found comparable success rates for both vaginal procedures.
"The two surgeries to correct apical prolapse performed equally, and that will allow specialists in this area to tailor the individual operation to a patient's specific needs using either of the surgeries," said study author Dr. Matthew Barber, professor of surgery at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.
Barber said the second message that came out of the study was that Kegel-type pelvic muscle exercises seem to offer no extra benefits as an addition to surgery.
The study included 374 women who underwent procedures between 2008 and 2013. The participants were randomly assigned to one of two surgery groups -- either sacrospinous ligament fixation or uterosacral ligament suspension. Both involve stitching the top of the vagina to ligaments inside the pelvic cavity.
After surgery, half of the women also received either behavioral therapy that included exercises to help strengthen muscles that support the uterus, bladder and rectum, or typical post-surgery follow-up care.
Two years later, both procedures had about a 60 percent surgical success rate, according to the study, published in the March 12 issue of the Journal of the American Medical Association.
Barber, who is also vice-chair of clinical research in the Ob/Gyn and Women's Health Institute at Cleveland Clinic, said about 300,000 women undergo pelvic organ prolapse surgery every year in the United States.
Dr. Quoc-Dien Trinh, a urologic surgeon at Brigham and Women's Hospital in Boston who was not involved in the research, said the study was important because it compared the effectiveness of two of the most commonly performed procedures to correct apical vaginal prolapse.
"This finding is quite important as both procedures are safe and both had comparable success rates," he said. The study also showed that pelvic muscle training may only hold benefits for a small subset of patients undergoing surgery for apical vaginal prolapse, and that it's a question that needs further study, he noted.
If both surgeries work equally well, how do a surgeon and patient choose the best option? Trinh said based on the lack of evidence supporting one technique over the other, surgeons should offer their patients the technique they're most familiar with and comfortable performing.
From the patient's perspective, an important factor will be the consideration of side effects, he noted. "For example, the rate of neurologic pain requiring intervention was higher in the [sacrospinous ligament fixation] group," Trinh said. But ureteral obstruction -- a blockage in one or both tubes (ureters) that lead from the kidneys to the bladder -- was only seen in the [uterosacral ligament suspension] group.
"Patients should choose the approach they are most comfortable with, given the potential adverse outcomes of each," said Trinh.
Barber said in some cases a surgeon might make the call in the operating room, after starting surgery. Knowing both procedures are equally effective and safe is reassuring and allows the surgeon to provide the best option, he explained.
Barber said he hopes the study will also bring attention to an issue a lot of women live with but hesitate to seek treatment for because they believe there are no solutions.
"It's a condition that's very common. Studies like this not only provide us with useful information but they raise awareness, and patients may be more likely to bring it up with their doctors," Barber said.
Visit the Women's Center for Pelvic Health at Johns Hopkins Medicine for more on women's pelvic health issues ( http://www.hopkinsmedicine.org/johns_hopkins_bayview/medical_services/primary_care/obstetrics_gynecology/clinical_services/gynecology/center_for_pelvic_health/ ).
SOURCES: Matthew Barber, M.D., M.H.S., professor of surgery, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, and vice-chair, clinical research, Ob/Gyn and Women's Health Institute; Quoc-Dien Trinh, M.D., division of urologic surgery, Brigham and Women's Hospital, Boston; March 12, 2014, Journal of the American Medical Association
U.S. Could Face Shortage of Cancer Doctors
Gap projected to reach nearly 1,500 specialists in a decade, American Society of Clinical Oncology cautions
TUESDAY, March 11, 2014 (HealthDay News) -- People fighting cancer might have to wait longer to see a cancer specialist in the coming decades, as demand for treatment outpaces the number of oncologists entering the workforce, a new report released Tuesday warns.
Demand for cancer treatments is expected to grow by 42 percent or more by 2025, while the supply of oncologists will only increase by 28 percent, experts found.
The mismatch between supply and demand could result in a shortage of nearly 1,500 oncologists by 2025, according to the American Society of Clinical Oncology (ASCO) report.
People living in rural areas will be hardest hit by the shortage, the report predicted. Currently, only 3 percent of oncologists are based in rural areas, even though that's where 20 percent of Americans live.
"We never want to have a cancer patient have to wait to get in to see a cancer physician," said Dr. Richard Schilsky, ASCO's chief medical officer. "Since we're aware of the issue, we are beginning to think about how to mitigate it."
Schilsky said he believes oncologists will need to rely on primary-care physicians, nurse practitioners and physician assistants to handle basic cancer treatment and follow-up care as demand for services grows. "That will leave the oncologists time to deal with the more complex cancer patients," he explained.
Certain factors will likely combine to increase the number of patients seeking cancer treatment in coming years, Schilsky said, including:
The aging of the baby boomer generation. "They are now all in their 60s, and that's the age at the highest risk for getting cancer," he said.
Improved cancer treatment. A record 13.7 million cancer survivors now live in the United States, Schilsky said, and many want to maintain a relationship with their oncologist even though they are cancer-free.
Health care reform. "There are going to be millions of people who didn't previously have health insurance and [who] will be seeking care for cancer," Schilsky said.
The total annual cost of cancer care in the United States is projected to reach $175 billion by 2020, an increase of 40 percent from 2010, according to the report.
The ASCO report predicted that there won't be enough cancer doctors on hand to meet this demand.
One expert not involved with the report agreed that a large gap in specialists is looming.
"I personally think it's a topic we know is going on in the oncology community, but when you're talking about the big picture of health care these things can get overlooked," said Dr. Janna Andrews, an attending physician in the department of radiation medicine at the North Shore-LIJ Cancer Institute in Lake Success, N.Y.
Andrews said people in rural areas already are feeling the effects of a shortfall. "You probably see that now in the more rural areas, where you are diagnosed with cancer and then you find the closest center to treat you is over two hours away," she said.
Another issue is that the field has its own aging workforce, the ASCO report noted.
"About 20 percent of currently practicing oncologists are now approaching the retirement age of 65," Schilsky said. The number of oncologists older than 64 exceeded those under 40 for the first time in 2008, and the gap is expected to widen.
Dr. Steven Paulson, an oncologist and hematologist at Texas Oncology, a US Oncology Network affiliate in Dallas, said some oncology practices are struggling.
"The challenges facing practicing medical oncologists are making it very difficult for small and even medium-sized oncology practices to survive," Paulson said. "Many older physicians will simply retire, worsening the shortages already projected."
And the supply of new graduates is not likely to keep pace with demand, according to ASCO. As pressure builds, many cancer doctors are likely to burn out and either reduce their clinical hours or leave the field altogether, the report suggested.
"Oncology is a very, very demanding specialty where you have to be available 24/7," Schilsky said. "You are dealing with people who face life-threatening illnesses, many of whom will succumb to that illness. There's this work-life balance we have to figure out how to deal with."
Oncologists might be able to help the situation by shifting some of their simpler cancer treatments to highly trained nurse practitioners or physician assistants. "Once they are properly trained, they have the skills to handle uncomplicated cancer patients," Schilsky said.
Primary-care physicians also can play a role, by taking over the care of cancer survivors. Oncologists can provide a "survivorship care plan" that will note the potential long-term side effects of a patient's cancer treatment, as well as their future cancer risk.
"By leveraging all of the resources in the health care system, we think we can mitigate a lot of this," Schilsky said.
The federal government also can help by steering more money toward training new oncologists.
Most new doctors require two to three years in an oncology fellowship before they are ready to practice, and Medicare pays for the first year of this training in virtually all cancer teaching programs, Schilsky said.
But Medicare funding for medical training has been ratcheting down, he said, and that has constrained the number of doctors who can seek out an oncology fellowship.
"It's limiting the availability of fellowship slots, even for people who are interested in getting that training," Schilsky said.
To read the full report on the state of cancer care, visit the American Society of Clinical Oncology (http://www.asco.org/stateofcancercare ).
SOURCE: Richard Schilsky, M.D., chief medical officer, American Society of Clinical Oncology; Janna Andrews, M.D., attending physician, department of radiation medicine, North Shore-LIJ Cancer Institute, Lake Success, N.Y.; Steven Paulson, M.D., oncologist and hematologist, Texas Oncology, US Oncology Network affiliate, Dallas; March 11, 2014, ASCO report, The State of Cancer Care in America: 2014
Alcohol Near Start of Pregnancy Linked to Premature Babies
Educated whites most likely to exceed drinking recommendations, British study finds
MONDAY, March 10, 2014 (HealthDay News) -- Women who drink before they conceive or during the first three months of pregnancy might be at increased risk of having a premature or small baby, new research finds.
The study included more than 1,200 pregnant women in the United Kingdom who provided information about their drinking habits shortly before and during pregnancy.
The U.K. Department of Health, like the U.S. Centers for Disease Control and Prevention, recommends that pregnant women and those trying to conceive should not drink any alcohol. If they do, they should limit alcohol to no more than one or two units a week, according to the U.K. guidelines.
Alcoholic content varies. In general, though, one large glass of wine can contain more than three units of alcohol -- more than the upper weekly limit.
The University of Leeds researchers found that 53 percent of the women drank more than the recommended maximum of two weekly units of alcohol per week during the first three months of pregnancy. Nearly 40 percent drank more than 10 units a week just prior to conceiving.
Those who drank more than two units a week were more likely to be white, older, have higher levels of education and live in richer neighborhoods, the researchers said.
About 13 percent of the babies born to the women in the study were underweight, 4.4 percent were smaller than normal and 4.3 percent were born prematurely. Women who drank more than two units of alcohol a week during the first three months of pregnancy were twice as likely to have a premature or small baby as those who did not drink, the study found.
But even women who drank less than two units a week during the first three months of pregnancy were more likely to have a premature baby than those who did not drink, the researchers said.
Women who drank just before they conceived were also more likely to have babies that were smaller than normal, according to the study, which was published online recently in the Journal of Epidemiology and Community Health.
The findings show that drinking during the first three months of pregnancy has the greatest impact on babies, the researchers said. The study also highlighted the need to emphasize to women that they shouldn't drink just before or during pregnancy.
Although the study showed an association between alcohol consumption and premature birth, it did not prove a cause-and-effect relationship.
The March of Dimes has more about alcohol and pregnancy (http://www.marchofdimes.com/pregnancy/alcohol-during-pregnancy.aspx# ).
SOURCE: Journal of Epidemiology and Community Health, news release, March 10, 2014
Excess Weight a Risk Factor for Ovarian Cancer: Report
Review adds the disease to long list of tumors linked to obesity
TUESDAY, March 11, 2014 (HealthDay News) -- A new report reveals that excess weight raises the risk of yet another kind of cancer, with the latest results linking levels of body fat to ovarian tumors.
The chances for developing many cancers -- such as postmenopausal breast, colorectal, endometrial, esophageal, kidney, gallbladder and pancreatic cancers -- are known to increase with a person's weight, but the evidence for any such link to ovarian cancer has been inconclusive until now, the report authors said.
"We estimated a 6 percent increase in [ovarian cancer] risk per five [points] increase in body-mass index," said report author Dr. Elisa Bandera, an associate professor of epidemiology at the Rutgers Cancer Institute of New Jersey, in New Brunswick. Bandera said the average woman's lifetime risk of ovarian cancer is 1.4 percent.
Body-mass index (BMI) is a rough estimate of a person's body fat based on weight and height. A BMI between 18.5 and 24.9 is considered normal. Between 25 and 29.9 is overweight, and 30 and over is considered obese, according to the U.S. Centers for Disease Control and Prevention.
Almost 600,000 people develop one of the eight cancers linked to overweight and obesity in the United States each year, according to the report compiled by the American Institute for Cancer Research and the World Cancer Research Foundation. If everyone were at a healthy weight, about one in five of those cancers -- or 120,000 cases of cancer a year -- could be prevented, according to the report.
"We know that obesity affects hormones known to affect the cancer process," Bandera said. "It also leads to insulin resistance and [high levels of insulin], as well as a chronic systemic inflammation. Inflammation, in particular, has been a major factor implicated in ovarian cancer development and is also associated with poorer survival."
Registered dietician Samantha Heller said she wasn't surprised by the report's findings.
"Research suggests that up to 90 percent to 95 percent of cancers may be preventable with diet and lifestyle," said Heller, the clinical nutrition coordinator at the Center for Cancer Care at Griffin Hospital, in Derby, Conn. "Of those, as many as 30 percent to 35 percent are linked to diet."
"Contrary to popular belief, fat cells are not the inert compounds we once thought," Heller said. "They are biologically very active cells that produce both anti-inflammatory and inflammatory compounds, as well as hormones and other chemicals."
"An excess of fat cells -- if someone is overweight or obese -- appears to knock off the body's delicate balance of health," Heller said. "This can lead to inflammation and hormonal imbalances, and can promote the growth of cancer cells."
The current report is part of an ongoing project. The last report was published in 2007, Bandera said.
Overall, the report included 25 population-based studies examining how diet, weight and physical activity might affect the risk of ovarian cancer. Ovarian cancer is the fifth leading cause of cancer deaths in the United States. A major reason for that is that ovarian cancer often isn't diagnosed until it's in the later stages.
Bandera and her colleagues concluded that body fat is likely a contributing factor to the development of ovarian cancer. The risk is greatest for those with a BMI over 30, she added.
Although the study found an association between body fat and ovarian cancer risk, it did not establish a cause-and-effect link.
The report also found that height is a factor in the development of ovarian cancer, with taller women at higher risk. The reason height is linked to ovarian cancer is unclear, Bandera said, although genetic factors and early growth rates might play a role.
"What this means for cancer prevention is that prevention efforts need to target the life course, not just adulthood, and families, not just individuals," Bandera said.
The researchers said they were unable to conclude if any dietary factors might be protective because there simply weren't enough studies to draw any conclusions.
For now, both experts said maintaining a healthy weight can help prevent some cancers.
"Because we also have evidence linking obesity to other cancers and other chronic diseases, maintenance of healthy weight through a healthy diet and regular exercise is a safe bet to live a healthy life," Bandera said.
Learn more about ovarian cancer from the American Cancer Society (http://www.cancer.org/cancer/ovariancancer/detailedguide/index ).
SOURCES: Elisa Bandera, M.D., Ph.D., associate professor, epidemiology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, N.J.; Samantha Heller, M.S., R.D., clinical nutrition coordinator, Center for Cancer Care, Griffin Hospital, Derby, Conn.; American Institute for Cancer Research and World Cancer Research Fund Continuous Update Project, Ovarian Cancer 2014 Report: Food, Nutrition and Physical Activity and the Prevention of Ovarian Cancer
Health Highlights: March 11, 2014
Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:
Cost of New Hepatitis C Drug Too High: Experts
Some health care experts are questioning whether a recently-approved hepatitis C drug is worth $1,000 a pill.
The price set for Sovaldi by manufacturer Gilead Sciences Inc. makes it a "low value" treatment in comparison to the cost of using older drugs, the California Technology Assessment Forum voted Monday, the Associated Press reported.
Using Sovaldi instead of current hepatitis C drugs would boost California's drug costs by $18 billion to $29 billion a year, according to the fourm, which is an insurance industry-associated group that gauges the cost and effectiveness of new treatments.
A final report on Sovaldi is expected to be released by the forum next month, along with its conclusions about another new hepatitis drug called Olysio, from Johnson & Johnson.
Sovaldi, which was approved late last year by the U.S. Food and Drug Administration, is taken once a day and cures between 80 and 90 percent of patients. Previous standard treatments for hepatitis C required taking up to 12 pills a day, which is effective in about 75 percent of patients, the AP reported.
While Sovaldi was enthusiastically received by doctors due to its convenience and better results, some health providers and patient groups are starting to question its cost. A 12-week course of the drug costs $84,000, and some patients need to take two courses.
State Medicaid providers should deny coverage for the drug until Gilead lower the price, the AIDS Healthcare Foundation said in January. It said that the drug's price "will unnecessarily drive up health care costs and limit access to potentially lifesaving care," the AP reported.
"AHF believes that the price Gilead is charging for Sovaldi is not remotely justified. For one, it is exponentially more expensive than medications for other severe chronic conditions," the group said.
For example, the cost of Sovaldi is 1,100 percent more than the $80 per pill that Gilead charges for its most costly HIV drug, Stribild, according to the foundation.
Gilead provides financial assistance to patients who aren't able to afford the drug and related insurance costs, a company spokeswoman told the AP. She added that many private insurers are already covering the drug.
7 Million Americans Have Artificial Joints: Study
More than two percent of Americans, or seven million people, have artificial hips or knees, a new study says.
Among people over age 50, five percent have a new knee and more than two percent have a new hip, according to the findings presented Tuesday at a meeting of the American Academy of Orthopaedic Surgeons, the Associated Press reported.
Each year in the U.S., people receive more than 600,000 knee replacements and about 400,000 hip replacements. However, this is the first study to examine how many Americans currently have joint replacements.
"They are remarkable numbers," study leader Dr. Daniel Berry, chairman of orthopedic surgery at the Mayo Clinic, told the AP.
The number of Americans with joint replacements is expected to rise as the population ages. One reason for the increase is that people have become less willing to put up with painful joints and know that joint replacements can help them, Berry said.
The number of knee replacements among Americans ages 45 to 64 more than tripled over the last decade, and nearly half of hip replacements now are in people younger than 65, according to federal government data.
Joint replacement is not for "anybody who has pain in the joint," Berry told the AP. He explained that it won't help people who have arthritis-related pain and stiffness but no joint damage.
People need to try exercise, medicines and weight loss before they consider joint replacement, Dr. Joshua Jacobs, chairman of orthopedic surgery at Rush University Medical Center and president of the orthopedic surgery association, told the AP.
Medicare Drug Plan Changes Withdrawn by White House
Proposed changes to the Medicare prescription drug program have been withdrawn by the Obama administration after strong opposition from patient groups.
The changes would have included removal of three classes of drugs -- antidepressants, antipsychotics and immune system-suppressing drugs used in transplant patients -- from a special protected list that guarantees seniors access to a wide number of important medications, the Associated Press reported.
It was estimated that the changes would save a total of $729 million by 2019. However, the proposal met heavy resistance from patient groups such as the National Alliance on Mental Illness and the National Kidney Foundation.
In a letter to Congress on Monday, Medicare administrator Marilyn Tavenner said the White House will not proceed with the changes, the AP reported.
Hip Replacement Safe for Patients in Their 90s, Study Finds
Complication rates similar to patients in their 80s and younger, researchers say
TUESDAY, March 11, 2014 (HealthDay News) -- As the population ages, more and more older people might need to have their hip joints replaced. But how old is too old to undergo the surgery?
According to a new study, patients in their 90s who need total hip replacement can have results comparable to younger patients.
"Our data show that [older] patients have the ability to do better than we expected," said lead researcher Dr. Alexander Miric, an orthopedic surgeon at Kaiser Permanente, in Los Angeles.
Over a 10-year period, Miric and his colleagues compared the results of hip replacement surgery in 183 patients who were aged 90 and above to the results of more than 43,000 other total hip replacement surgeries performed on younger patients.
"Being in your 90s need not disqualify you from having a hip replacement surgery," Miric said.
He is scheduled to present the findings Tuesday at the annual meeting of the American Academy of Orthopaedic Surgeons, in New Orleans.
Hip replacement surgery, often needed because of the wear-and-tear arthritis known as osteoarthritis, has been done since 1960, according to the academy, but techniques have improved. About 285,000 total hip replacement procedures are done annually in the United States, according to the U.S. Agency for Healthcare Research and Quality.
Miric's team looked at data collected by a total joint replacement registry. They analyzed hip replacement surgeries done from April 2001 through December 2011.
The researchers compared three age groups: younger than 80, 80 to 89 and 90 and older. They compared the lengths of the hospital stay, complications after surgery, death rates and readmissions to the hospital up to 90 days after the surgery.
Although none of the patients 90 and older had serious blood clots known as deep vein thrombosis, 1.2 percent of the those aged 80 to 89 did. Meanwhile, less than 1 percent of the younger patients did.
"Compared to those under 80, they did not have higher rates of infection," Miric said of the patients over 90.
The oldest patients did stay in the hospital a bit longer: 3.4 days on average, compared to 2.8 days for the youngest patients and 3.3 days for the 80- to 89-year-olds.
The oldest patients also were more likely to be readmitted within the three months after the surgery.
And the oldest had the highest death rates within the 90-day follow-up period -- 2.7 percent compared with 1.3 percent for patients aged 80 to 89 and 0.2 percent for those under 80.
Miric said the bottom line for nonagenarians with worn-out hips is optimistic: "If you are in your 90s, it is reasonable to have that conversation [about surgery] with your surgeon."
The study results are not surprising, said Dr. Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago. He reviewed the findings but was not involved in the study.
He, too, has performed total hip replacement surgery on 90-year-olds with good results, he said. "Most folks who live to 90 years old and have symptomatic arthritis are generally a pretty hardy crowd," he said. "If they are healthy enough that their arthritis bothers them, it usually means they are active and can tolerate elective surgery."
He cautioned, however, that patients of this age, as well as other ages, need a thorough preoperative evaluation to be sure they are good candidates for the procedure.
However, he said, the death rate of 2.7 percent found in the study for those 90 and above seems high.
In response, Miric said the one-year death rate of people 90 and above, in general, is about 20 percent. In his study, however, the one-year death rate of the 90-and-up group was 5.5 percent.
Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
To learn more about hip replacement surgery, visit the American Academy of Orthopaedic Surgeons (http://orthoinfo.aaos.org/topic.cfm?topic=a00377 ).
SOURCES: Alex Miric, M.D., orthopedic surgeon, Kaiser Permanente, Los Angeles; Craig Della Valle, M.D., professor, orthopedic surgery, Rush University Medical Center, Chicago; March 11, 2014, presentation, American Academy of Orthopaedic Surgeons annual meeting, New Orleans
Knee Pain May Not Be Helped by Glucosamine
Popular supplement did not reduce cartilage damage or improve joint function in study
TUESDAY, March 11, 2014 (HealthDay News) -- The dietary supplement glucosamine does not slow cartilage damage in people with chronic knee pain, according to a new study.
Millions of Americans take glucosamine in an effort to treat osteoarthritis of the knee and other joints. The most common form of arthritis, osteoarthritis is related to normal wear and tear of the joints.
The new study, published online March 11 in the journal Arthritis & Rheumatology, included about 200 people with mild to moderate pain in one or both knees. They were randomly selected to drink 1,500 milligrams a day of glucosamine or a placebo added to a 16-ounce bottle of diet lemonade for 24 weeks.
MRI scans were used to assess cartilage damage in the patients' knees. Reductions in cartilage damage were no greater in the glucosamine group than in the placebo group, and taking glucosamine did not reduce knee pain, according to a journal news release.
"Our study found no evidence that drinking a glucosamine supplement reduced knee cartilage damage, relieved pain or improved function in individuals with chronic knee pain," said researcher Dr. C. Kent Kwoh, director of the University of Arizona Arthritis Center.
A 2007 survey found that 10 percent of American adults used glucosamine.
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about knee problems (http://www.niams.nih.gov/Health_Info/Knee_Problems/default.asp ).
SOURCE: Arthritis & Rheumatology, news release, March 11, 2014
New Knees, Hips May Also Help the Heart
Joint replacement might boost physical activity in arthritis patients, study author says
TUESDAY, March 11, 2014 (HealthDay News) -- A knee or hip joint replacement may provide a surprising benefit: better heart health.
In a study of 2,200 people older than 55 with arthritis, researchers found that the odds of a serious heart problem or death were 37 percent lower in people who had a knee or hip replacement compared to those who didn't have such surgery.
"Arthritis is associated with an increased risk of cardiovascular disease and cardiovascular death. It is possible that arthroplasty can reduce these risks," said lead study author Dr. Bheeshma Ravi, a physician in the division of orthopedic surgery at the University of Toronto.
Total joint arthroplasty is the medical name of the surgery to replace a hip or knee joint. Patients in the study had osteoarthritis, the type of arthritis associated with normal wear and tear on the joints.
While the study found a link between having joint replacement surgery in people with arthritis and reduced risk of heart events, it did not prove a cause-and-effect relationship.
"Our finding is new and it is provocative. It needs to be borne out in other studies," Ravi said.
He explained that people who have moderate to severe arthritis often have other conditions, such as high blood pressure and type 2 diabetes, which are often related to physical inactivity.
"When you look at the activity levels recommended by the American Heart Association and other guidelines, it's not a lot of activity -- about 30 minutes a day -- but a lot of people can't do this with arthritis," Ravi explained.
The researchers looked at data from people with moderate to severe arthritis who were living in the community. All were over age 55, and arthritis was confirmed with X-rays. The study began in 1996, and those in the study were followed until their death or 2011.
To address the concern that people having surgery might be healthier than those opting not to have surgery, Ravi and his colleagues matched people who had surgery to those who didn't by age, gender and other health conditions. They also eliminated anyone who had surgery within the first three years of the study.
The final analysis contained 162 matched pairs. People who had surgery lowered their odds of a serious heart event or death by 37 percent, the results indicated.
Ravi said the most likely reason for the decline in risk was the ability to be more physically active. He said there are other theories, such as that arthritis may increase inflammation, which increases heart attack risk, and that by replacing the joint, inflammation may be reduced.
Another possibility is that pain medications may increase the risk of heart problems, or that pain and the stress effects of pain may increase the risk of heart problems. Ravi said it may be that all of the above factors play some role, but the researchers suspect that increased mobility is likely the one that has the most impact on heart risk.
Another expert called the study "very encouraging."
"Orthopedic surgeons are often used to taking care of healthier populations, and they may be reticent to do surgery on someone with heart disease," said cardiologist Dr. John Erwin III, an associate professor and vice chair of the department of internal medicine at Baylor Scott & White Healthcare in Temple, Texas.
"While obviously there are risks to surgery, even previous heart patients can go on to do well after joint replacement surgery, and their quality of life improves," Erwin said.
Erwin agreed that the ability to move more likely made the biggest difference in heart risk. In addition to the physical benefits, he said getting their independence back also makes a big difference in patients' depression symptoms, which can also affect heart risk.
There are risks to joint replacement surgery. These include damage to the tissues and nerves, infections, the need for reoperation, blood clots and even death, according to study author Ravi. "The benefits of surgery need to be weighed carefully against the risk. If you're fairly unhealthy, surgery could be a problem," he said.
And, people need to know that the recovery time is long. "Most studies show that people start feeling a lot of benefit by six months, though that's variable. People can usually return to activities in six months to a year," Ravi said.
For people with more severe arthritis, Ravi said that there aren't a lot of other options. Medical management with painkillers or injections can help with earlier stages of the disease, but not as much when arthritis is more advanced. He said if arthritis is interfering with your daily life, and keeping you from doing the things you want to do, you might want to talk with your doctor about surgery.
Ravi and his colleagues are scheduled to present their findings Tuesday at the annual meeting of the American Academy of Orthopaedic Surgeons, held in New Orleans. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.
Learn more about joint replacement surgery from the U.S. National Institutes of Health (http://www.niams.nih.gov/Health_info/Joint_Replacement/default.asp ).
SOURCES: Bheeshma Ravi, M.D., Ph.D., physician, division of orthopedic surgery, department of surgery, University of Toronto; John Erwin III, M.D., senior staff cardiologist, associate professor and vice chair, department of internal medicine, Baylor Scott & White Healthcare, Temple, Texas; March 11, 2014, presentation, American Academy of Orthopaedic Surgeons annual meeting, New Orleans
Preschoolers Beat College Kids at Figuring Out Gadgets
Researchers say the very young take more flexible approach to problem-solving
TUESDAY, March 11, 2014 (HealthDay News) -- When faced with a strange, new gizmo, preschoolers figured out how it worked more quickly than college students did, a new study shows.
The likely reason, according to the researchers, is that very young children may be less fixed than adults in their ideas about cause and effect.
The study included 106 young children, aged 4 and 5, and 170 college students who were asked to figure out a gadget that worked in an unusual way. They did this by placing different clay shapes on a special box to find out which shapes -- single or together -- could light up the box and play music.
The children were quicker than the college students to understand that unusual combinations of shapes could make the box perform, according to the study, which will be published in the May issue of the journal Cognition.
"The kids got it. They figured out that the machine might work in this unusual way and so that you should put both blocks on together," senior study author Alison Gopnik, a developmental psychologist at the University of California, Berkeley, wrote in a column last week for The Wall Street Journal.
"But the best and brightest [college] students acted as if the machine would always follow the common and obvious rule, even when we showed them that it might work differently," Gopnik said.
"As far as we know, this is the first study examining whether children can learn abstract cause- and-effect relationships, abstract principles about the logical form of causal relationships, and comparing them to adults," Gopnik said in a university news release.
"One big question, looking forward, is what makes children more flexible learners -- are they just free from the preconceptions that adults have, or are they fundamentally more flexible or exploratory in how they see the world?" study author Christopher Lucas, a lecturer at the University of Edinburgh in Scotland, said in the news release.
"Regardless, children have a lot to teach us about learning," he added.
The U.S. Centers for Disease Control and Prevention has more about preschoolers (http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/preschoolers.html ).
SOURCE: University of California, Berkeley, news release